Compounding Risk: Sexual Minority Youth & Injection Drug Use

Oftentimes, raw statistics can fail to convey the severity or urgency of a public health crisis. When seen from the vantage point of a scholarly paper or spreadsheet, they have a tendency to become divorced from the realities they seek to describe. Stare at a number long enough, like the roughly 44,000 Americans who were newly diagnosed with HIV in 2014, for instance, and the magnitude and human impact of that many people receiving a life altering HIV diagnosis can get lost. However, occasionally a statistic will appear that is so jarring—so disturbing—that it manages to rattle even the most seasoned researcher or advocate. A recent study from the Centers for Disease Control looking at HIV-related risk behaviors among sexual minority youth in the United States contained one such statistic: 10.1%.

According to the CDC’s 2015 Youth Risk Behavior Survey, a staggering 10.1% of gay and bisexual male high school students across the country have ever injected a drug into their body. Just stop and think about that for a moment. If the findings of that survey are in fact indicative of the behaviors of high schoolers nationwide, that means that roughly 1 out of every 10 gay and bisexual male students have engaged in injection drug use. That statistic, while terrifying in its own right, looks even worse when juxtaposed against the survey results for heterosexual male high schoolers, among whom only 1.5% had ever injected drugs—a rate of injection drug use nearly 7 times less than their gay and bisexual counterparts.

“That 10.1% number garnered a lot of attention,” said Dr. Laura Kann, chief of the School-Based Surveillance Branch of the CDC’s Division of Adolescent and School Health. “It’s a really heartbreaking number and we we’re hoping it draws a big response.”

This massive gap in injection drug use between gay and bisexual male high school students and their heterosexual peers was also reflected in the rates of heavy non-injection drug use among the two groups. The CDC found that gay and bisexual male students were 8 times more likely to have tried heroin, 6 times more likely to have tried methamphetamines and over 3 times more likely to have tried cocaine and ecstasy than heterosexual male students.

Dr. Kann, who was the lead author on the CDC report that sifted through all of this data, said that more research needed to be done to determine what the long term impacts or root causes of the large imbalance in drug use between gay and bisexual and heterosexual male youth are, but indicated that the numbers all point in one direction.

“The Youth Risk Behavior Survey doesn’t tell us why. It just tells us what kids are doing,” she said. “But, we know from other sources that these risk behaviors share some common risk factors, so you’ve got to think there’s some link between the stress that sexual minority youth face and their level of drug use.”

A quick look at some of the differences between gay and bisexual male high schoolers and their heterosexual classmates in other health-related behaviors tracked by the Youth Behavior Risk Survey shows that the huge gap in both injection and non-injection drug use is only one part of a larger constellation of health risk behaviors that differ significantly based on sexual identity. School bullying, forced sexual intercourse, prolonged feelings of hopelessness, suicide attempts—the likelihood of all of these negative health outcomes happening to a young man in high school are significantly increased simply by being gay or bisexual.

As was made terrifyingly clear in Scott County, Indiana earlier this year, injection drug use can transmit HIV unbelievably quickly if the conditions are right. And, if this CDC report suggests anything, it is that the pump is being primed for similar outbreaks in the future involving gay and bisexual high school males. Even if the rates of injection drug use and the other aforementioned health-related behaviors of gay and bisexual and heterosexual males in high school were the same, the risk of contracting HIV would be much higher for the gay and bisexual students, given that studies suggest anal sex can be up to 18 times riskier than vaginal sex and that American men who have sex with men have an HIV prevalence rate that is 57.5 times greater than other US men. Unfortunately, those health-related behaviors among gay and bisexual and heterosexual high school males are not the same—and the risks of HIV exposure for youth based on sexual identity continue to widen.

In many ways, the prevention and treatment measures that advocates can take to lower rates of injection drug use and HIV infection in gay and bisexual teenagers are no different than they are for heterosexual teens. It is vital to the health and wellbeing of all young people that they receive comprehensive sexual and drug education and that, if they do engage in injection drug use, they be provided with access to an array of harm reduction interventions ranging from syringe access programs and opioid substitution therapy to HIV testing and mental health services. But, in other ways, the challenges facing sexual minority youth are unique and require a much different response.

There can be little doubt that the stress and stigmatization experienced by gay and bisexual youth is a driving factor behind patterns of illicit drug use that are up to 7 and 8 times greater than their heterosexual peers. One recent study published in the journal Drug and Alcohol Dependence showed that sexual minority youth use of marijuana was significantly greater in neighborhoods with a higher prevalence of assault hate crimes against sexual minority youth while heterosexual use was unaffected. Another in the journal Drug and Alcohol Review, revealed that 58% of the sexual minority youth they surveyed felt as if homophobia and discrimination had effected their alcohol and/or drug use. In isolation these sorts of studies aren’t exactly definitive, but, when taken together in conjunction with numbers like those garnered from the Youth Behavior Risk Survey, the verdict seems clear.

The disparities between sexual minority youth and their heterosexual counterparts as it relates to injection drug use is not a direct result of their sexual identity. Rather, the data suggests that it is the experience of growing up in a society that often permits and—as has been the case in places like North Carolina—even encourages the stigmatization and shunning of sexual minority youth, that has created an environment where 1 in 10 gay and bisexual high school students have injection drug use histories. And, as a result, perhaps the most crucial means by which the tide of injection drug use that so disproportionately effects gay and bisexual youth may be stemmed is through sustained and massive mobilization against the homophobia and prejudice the creates the vacuums into which those drugs are poured.